Mixed-Pattern Ameloblastoma of the Anterior Mandible: A Rare Histopathological Presentation at an Infrequent Location.

Ameloblastoma is a benign odontogenic tumor of epithelial origin that exhibits a locally aggressive behavior with a high level of recurrence and multiple factors involved in its molecular pathogenesis. This article is a case report of a 46-year-old male patient suffering from a progressively enlarging tumor of the anterior mandible that caused gradual expansion of the lingual cortical plate and root displacement without resorption of the involved teeth. Incisional biopsy was consistent with "conventional" ameloblastoma, showing a mixed pattern of both the follicular and acanthomatous subtypes. This diagnosis was corroborated through a histopathological examination of the resected specimen. The patient was submitted to en bloc resection (marginal mandibulectomy) with preservation of the lower mandibular border; dental rehabilitation was achieved through a removable prosthesis. He remains disease-free for 5.5 years postoperatively and is highly satisfied with mastication and speech. The objective of this report is to highlight a relatively rare histopathological presentation of the "conventional" ameloblastoma, involving a site not commonly affected by ameloblastomas, the anterior mandible and crossing the midline, in a relatively young male patient.

Surgical treatment of oral and facial soft tissue cystic lesions in children. A retrospective analysis of 60 consecutive cases with literature review.

OBJECTIVES: To present the experience in the treatment of soft tissue cysts of the orofacial region in children treated at the Department of Oral and Maxillofacial Surgery at Children's Hospital "A. and P. Kyriakou", Dental School, University of Athens. STUDY DESIGN: This is a retrospective study including 60 young individuals, 4 months to 14 years old. Surgical treatment was provided under general anaesthesia, during a 13-year period from 2000 to 2012. RESULTS: The majority of cysts were mucoceles (n = 36, 60.0%), followed by ranulas (n = 15 or 25.0%), dermoid cysts (n = 4 or 6.6%), branchial cysts (n = 2 or 3.3%), thyroglossal duct cysts (n = 2, 3.3%) and one case of cystic hygroma (n = 1 or 1.6%). The primary method of treatment was enucleation and secondary marsupialization. CONCLUSION: It is very important to appreciate that although soft tissue cysts are benign lesions, some of them may grow to a large size and become a major threat, especially in developing orofacial regions in children. In addition, as some types of soft tissue cysts such as cystic hygroma show a tendency to recur, early examination and follow-up is required for the young population.

Development of surgical techniques of secondary osteoplasty in cleft patients following 12 years experience.

PURPOSE: To evaluate the results of secondary osteoplasty in cleft patients, over a 12 years period, and to propose certain modifications and improvements of the cleft repair technique. MATERIALS AND METHODS: Data were retrieved for all young patients treated from 2000 to 2011. Patients were divided in 3 groups, of 4 years duration each; parameters registered among others included peri-operative orthodontics, type of graft used, techniques applied and revisions required until final repair. RESULTS: 65 patients (mean age 11.6 years) were included in the study. 80 cleft sites were treated. All clefts were finally repaired and bone continuity was achieved. Peri-operative orthodontics was applied in 84.6% of the cases. Bone grafts were harvested 60 times (84.5%) from the left anterior iliac crest and 11 times (15.5%) from the genial region of the mandible. During the 12 years period ameliorations and changes were made at the recipient site, regarding the technique applied and the type of the graft. Revision operations for additional bone grafting were required in 6 cases in all (6/80 or 7.5% of the cleft sites). A gradual reduction of the number of revision osteoplasties was recorded in the 3 time periods, attributed to the improvements afore mentioned. CONCLUSIONS: Cleft bone repair, even in difficult bilateral cases, may be achieved with standardised preparation of the recipient site, adequate graft from the iliac crest, used in the form of both particulate bone and cortical plate on top, as well as full coverage of the graft.

Benign fibro-osseous lesions of the jaws in children. A 12-year retrospective study.

INTRODUCTION: Fibro-osseous lesions, a diverse group of bone disorders including developmental, reactive or dysplastic diseases and neoplasms, share overlapping clinical, radiographic and histopathologic features and demonstrate a wide range of biological behaviour. AIM: To evaluate the characteristics, treatment and outcome of benign fibro-osseous lesions of the jaws in children. PATIENTS AND METHOD: All patients with fibro-osseous lesions of the jaws treated at the department of Oral and Maxillofacial Surgery of the «A & P Kyriakou¼ Children's Hospital of Athens from 2000 to 2011 were included in this study. Data were retrieved from patients' files and their present situation was registered. RESULTS: Sixteen males and 10 females (mean age 8.5 years) were treated. Fibrous dysplasia was most often encountered (26.9%), and the mandible was the most frequent location (76.9%). All cases were surgically treated and histopathologically confirmed. Marginal ostectomy was performed in 7 cases, partial ostectomy in 4, enucleation and curettage in 10 and trimming-remodelling in 5 cases. Mean follow-up was of 5.5 years with no recurrence, except in one case of fibrous dysplasia. CONCLUSIONS: Fibro-osseous lesions, although sharing similar microscopic features, exhibit a variety of clinical behaviour rendering their treatment highly individualized.

Hybrid odontogenic ghost cell tumor and cutaneous pilomatrixoma: a highly unusual coexistence.

This article describes the first published case of coexistence in a child of a rare hybrid odontogenic ghost cell tumor and a solitary cutaneous pilomatrixoma. An 11-year-old boy presented with a large well-defined unilocular radiolucent lesion in the right posterior mandible. Marsupialization followed by enucleation of the remaining lesion at a later period was the treatment of choice. Histopathologic analysis revealed a hybrid tumor demonstrating areas identical to calcifying cystic odontogenic tumor, ameloblastoma, ameloblastic fibro-odontoma, ameloblastic fibromyxoma, and adenoid odontogenic tumor. A cutaneous nodule was also removed from the facial area and demonstrated classic features of pilomatrixoma on histopathology. Sixteen cases of hybrid calcifying cystic odontogenic tumor associated with odontogenic tumors other than ameloblastomas and odontomas are referred in the literature to date. Young males are frequently affected, and the mandible is the most common site of involvement. The occurrence in the same patient of 2 distinctive entities, which both demonstrate ghost/shadow cells, may be a coincidental finding or suggest a common origin regarding the histogenesis of these cells. Alternatively, future molecular studies may clarify possible genetic or/and predisposing factors for the development of these lesions.

Histopathologic study of the carotid sheath in patients with oral squamous cell carcinoma.

PURPOSE: The carotid sheath has not been adequately assessed in the literature as a potential site of neck recurrence. The purpose of this prospective study was to investigate the histopathologic characteristics of the carotid sheath in patients with oral cancer, in an effort to clarify whether it is essential or redundant to include the carotid sheath in the neck dissection specimen. PATIENTS AND METHODS: A total of 29 patients underwent 32 selective neck dissections in the Department of Oral and Maxillofacial Surgery at "Evangelismos" General Hospital of Athens, Greece. Twenty-six unilateral and 3 bilateral neck dissections were performed. The carotid sheath specimens were examined to identify possible traces of metastatic disease. The existence of lymphatic vessels and the possible presence of cancer cells within their lumen was also investigated. RESULTS: Light microscopy of the 32 carotid sheath specimens showed that there was no evidence of tumor invasion. Immunohistochemical evaluation showed an abundance of lymphatic vessels in the carotid sheath with no evidence of microscopic intraluminal metastatic emboli. CONCLUSIONS: There was no evidence of carotid sheath invasion or presence of intraluminal lymphatic tumor emboli. Evidence of extracapsular spread warrants carotid sheath excision. Our findings suggest that if no extracapsular spread is present, there is no need to perform a tedious dissection of the carotid sheath. Preserving the carotid sheath adds protection to the neurovascular bundle, cuts operating time, and avoids possible injury to the major vessels and vagus nerve, as well as stimulation of the carotid body.